Key Points

• Berberine is a natural plant compound that may help improve insulin sensitivity, which is important since 60-70% of people with PCOS have insulin resistance
• Research suggests berberine can lower blood sugar levels, lower testosterone levels, and promote more regular menstrual cycles in women with PCOS.
• Berberine is known to interact with certain prescription drugs and some experience side effects. 
• Always consult your doctor before taking berberine for PCOS. A dietitian can help manage your symptoms with a personalized diet plan, whether you use berberine or not.

Berberine for PCOS: All you need to know 

If you have Polycystic Ovary Syndrome (PCOS), you already know how challenging it can be. Living with irregular periods, acne, frequent hair removal needs, weight gain, fertility concerns, extreme fatigue, bloating, and other symptoms can be overwhelming. 

Add the stresses of meeting the demands of daily life on top of all this—it's a significant burden to carry.

Naturally, you want solutions that help you feel better. Since PCOS doesn't have a cure, management typically focuses on addressing the underlying hormonal imbalances and easing your symptoms.

Berberine—a bright yellow compound found naturally in several plants—has recently gained attention for potentially helping with PCOS, diabetes, weight loss, and other health concerns.

But what does the science actually tell us? Is berberine worth taking for PCOS? What benefits might it offer, and are there any risks?

To help you make an informed decision, let's take a closer look at berberine and what experts like Registered Dietitian Brooke Miner, RD, have to say about managing PCOS effectively.

What is Berberine?

Berberine is a natural compound found in several plants, including barberry, goldenseal, goldthread, Oregon grape, and tree turmeric. It has a long history of being used in traditional Chinese and Indian medicine.

Modern research is now exploring berberine's effects on metabolism, blood sugar, and hormonal health—all areas directly connected to PCOS management. In particular, how berberine affects insulin in our bodies may help many with PCOS.

What is PCOS?

“Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting up to 1 in 10 women of reproductive age. It is one of the leading causes of infertility,” says Miner, RD. “Additionally, women with PCOS are at a higher risk of developing type 2 diabetes and cardiovascular disease later in life”.

Signs of PCOS

If you have PCOS, you might experience hormonal imbalances, including higher levels of male sex hormones (androgens like testosterone). These hormonal changes can create a host of health issues that you may be dealing with.

Common signs of PCOS include:

• Irregular periods
• Extra facial and body hair
• Acne
• Weight gain, especially around the middle
• Darkened skin patches
• Small cysts on the ovaries

PCOS is a metabolic disease

Despite its name, PCOS doesn't always involve cysts; it’s actually more complex. In recent years, research shows that PCOS is primarily a metabolic condition. The main driver appears to be insulin resistance, which affects how your body processes sugar.

Without proper management, this insulin resistance can increase the risk of developing type 2 diabetes—in fact, more than half of women with PCOS develop type 2 diabetes by age 40 if the condition isn't addressed.

Apart from a greater risk of type 2 diabetes and heart disease, PCOS can also lead to:

• Infertility
• Higher risk of gestational diabetes during pregnancy
• Higher blood pressure and cholesterol levels
• Sleep apnea
• Potentially, even mood disorders like depression and anxiety

PCOS treatment

Treating PCOS is highly personalized and focuses on addressing specific symptoms, together with diet and lifestyle changes.

Typically, healthcare providers may prescribe metformin, a common diabetes medication, to address insulin resistance along with weight management strategies. The medical community is beginning to evaluate berberine supplements for their potential role in PCOS management.

How does berberine help with PCOS?

According to Miner, RD, “Berberine can be a beneficial part of a care plan for PCOS, particularly for the 60-70% of people with PCOS who have insulin resistance. Berberine can help lower blood sugar levels, improve insulin sensitivity, reduce testosterone levels, and promote regular ovulation, potentially supporting more regular cycles and fertility.”

Understanding how berberine works helps explain why it may benefit multiple PCOS symptoms.

Controls blood sugar

When it comes to insulin resistance, berberine helps in two main ways: it helps your body make more insulin and makes it easier for insulin to do its job. This allows more sugar to enter your cells and helps your cells use that sugar better.

Research comparing berberine to metformin shows both work about equally well at helping the body use insulin better in women with PCOS. When insulin function improves, many PCOS symptoms may decrease as the treatment targets insulin resistance—a key underlying factor of the condition.

However, while these findings are promising, berberine research is still preliminary and lacks peer review by experts in the field. While some use berberine for diabetes as a complement to traditional therapy, metformin remains the standard treatment due to its established safety record and long history of clinical use.

Balances testosterone levels

Women naturally have testosterone too—just much less than men. But PCOS can throw off this balance, causing higher levels of testosterone and other male hormones (androgens). That's why treating PCOS often means finding ways to bring these hormone levels back down.

A review of eight studies found that berberine can decrease free testosterone levels and other androgen markers in women with PCOS. This could be because berberine works by reducing the activity of certain enzymes involved in producing testosterone and other male sex hormones.

This hormone-balancing effect could potentially influence symptoms like excess hair growth, acne, and scalp hair thinning.

Regulates menstrual cycles

Many women with PCOS struggle with irregular or missing periods. This isn't just a minor inconvenience—it's a sign of hormone problems that can affect your fertility and health. Bringing your periods back to a regular schedule is an important part of managing PCOS.

A handful of studies (with small groups of people) showed that taking berberine helped women with PCOS start having regular periods again.

While these results sound promising, keep in mind that research is still in the early stages. Scientists don't yet know how berberine might affect your body long-term. Also, in these studies, people also ate less and exercised regularly—lifestyle changes that can help lower insulin resistance and manage PCOS.

Could lead to moderate weight loss

Research suggests that berberine may help with weight management, though the effects aren't dramatic. A review of 12 controlled studies found that people taking berberine typically lost around 5 pounds over three months. Their BMI dropped by about half a point, and they saw small reductions in waist size.

While these changes may seem modest, even minor weight loss can make a meaningful difference. Losing just 5-10% of body weight can help improve insulin sensitivity and symptoms of PCOS.

Lowers cholesterol and triglycerides

Berberine seems to benefit heart health in several ways, which matters for people with PCOS since this condition raises the risk of heart disease. Berberine has been shown to lower total cholesterol levels (lowering "bad" LDL cholesterol and boosting "good" HDL cholesterol), reduce triglycerides (types of fat in the blood), and decrease inflammation.

It’s worth noting that studies on berberine are relatively small and short-term. Larger, longer clinical trials would help confirm these cardiovascular benefits in people with PCOS specifically.

Should you take berberine for PCOS?

Berberine can be part of your PCOS treatment plan, but it affects your blood sugar, cholesterol, and hormones. It can also interact with prescription medications. If you have PCOS and are interested in berberine, talk to your healthcare provider first and only take it with medical supervision.

While the research on berberine looks promising, managing PCOS usually involves several approaches working together. There's no single solution that works for everyone—what helps most is a plan tailored to your specific body and symptoms.

Diet and physical activity play a major role in managing PCOS, with or without medications or supplements like berberine.

The best PCOS diet

Expert dietitian Brooke Miner, RD, advises, "Managing PCOS through diet is about supporting the balance of key hormones that influence symptoms (like insulin, androgens like testosterone, and progesterone) and overall health. It's about finding what works best for you and fueling your body in a way that supports your unique needs, preferences, and symptoms."

For most people, a good PCOS diet means eating whole, nutrient-rich foods like lean proteins, healthy fats, and low-glycemic carbs while cutting back on processed foods and sugar. Adding anti-inflammatory foods like leafy greens, berries, and fatty fish can help ease symptoms.

Many find the Mediterranean diet helpful, with its focus on whole foods and healthy fats. Others might do better with a low-carb diet or an anti-inflammatory diet.

The most important thing is discovering what works for your body. A registered dietitian who understands PCOS can help create a plan that fits your life and food preferences.

Physical activity

Regular physical activity is one of the most effective ways to improve insulin sensitivity and manage PCOS symptoms. Both cardiovascular activities (like walking, swimming, dancing, or cycling) and strength training can help your body process insulin more efficiently.

Aim for about 150 minutes of moderate activity weekly, spread across several days, plus 2-3 strength training sessions. But remember, the best exercise is the kind you'll actually do consistently, so choose activities you enjoy.

If getting regular exercise feels too challenging right now, try taking small steps instead. While a 30-minute walk after meals helps lower your insulin resistance, even 10 minutes is a great start. You don't need to commit to lengthy workout sessions to start seeing benefits for your health.

What to know about berberine before taking it

Before you consider berberine, here's what you should know:

• Berberine supplements are not regulated: Berberine is a dietary supplement and not a medication. It has not been authorized by the FDA for treating medical conditions
• Research on berberine is limited: While berberine research sounds promising, most studies are small in size. Plus, longer-term data is needed
• No established berberine dosage: Studies typically use 500 mg taken 2-3 times daily with meals
• Potential side effects: Berberine is considered safe, but some people experience digestive side effects like constipation, diarrhea, or stomach discomfort
• Drug interactions: Berberine can interfere with medications, including blood pressure drugs, antibiotics, diabetes medications like metformin, cyclosporine (an immunosuppresant), and blood thinners like warfarin. It may also affect medications processed by certain liver enzymes, potentially changing their blood levels
• Risk of low blood sugar: Since berberine lowers blood sugar levels, there is a risk of hypoglycemia (low blood sugar), which can be dangerous, particularly when taken with existing blood sugar lowering diabetes medications. So, if you have PCOS or diabetes, do not take berberine without medical supervision
• Who should avoid berberine: It's not recommended for those who are pregnant or breastfeeding

Final thoughts: Should you take berberine for PCOS?

Berberine shows some promising benefits for PCOS by potentially improving insulin resistance, balancing hormones, and helping regulate periods. However, the research is still limited, and it's not FDA-regulated.

The most effective approach to PCOS is one tailored to your unique body and symptoms, combining the strategies that work best for you. Before trying it, you should talk with your healthcare provider, especially if you take other medications, since berberine can interact with several drugs.

Remember that diet and physical activity remain the cornerstones of managing PCOS—supplements like berberine might complement these efforts but shouldn't replace them.

Get relief from PCOS with a registered dietitian who accepts your insurance.

Frequently Asked Questions (FAQ)

What’s better for PCOS, metformin or berberine?

Early studies show that berberine may be equal to metformin in managing glucose levels and insulin sensitivity. But they both work in different ways. Metformin reduces the glucose production in the liver. Berberine is believed to activate AMPK, which enhances insulin sensitivity and helps our cells take in glucose from the blood much better.

However, metformin has long-term studies proving its effectiveness and safety, while berberine does not, so it continues to be the standard of care to treat insulin resistance related to PCOS. Talk to your doctor if berberine supplements can be a part of your overall PCOS treatment plan.

Can I replace metformin with berberine?

No, you should not replace existing PCOS medications with berberine without medical guidance.

While berberine shows promise in early research, studies are still limited. Traditional medicine uses small amounts of berberine found in plants. However, modern supplements are more concentrated versions of highly processed berberine. And this industry is not well regulated, so you may not always get the amount or quality that the brand promises.

If you're considering berberine for PCOS, always consult your healthcare provider first and look for quality brands that undergo third-party testing and certification. Additionally, a registered dietitian who specializes in PCOS can help you manage the condition.

What’s better for PCOS: berberine or inositol?

Berberine and inositol actually work in two different ways. Inositol (a type of sugar alcohol produced naturally in the body) modulates the hormone insulin itself and increases insulin sensitivity.

Berberine, on the other hand, activates enzymes that increase the amount of energy we expend and reduce fat storage. It may also reduce testosterone levels and help with weight loss.

So, do you need one or the other, or both? The answer depends on how PCOS affects your body and how you respond to treatment, including diet, medications, and any supplements you may take. To learn if berberine or inositol is right for you, talk to your doctor. You may also consult a PCOS dietitian to help guide you with a personalized plan to manage your PCOS.

Note: Both berberine and inositol are not authorized by the FDA to treat PCOS.

Find a PCOS dietitian who accepts your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.